Introduction
Spinal cord sends messages between the brain and the rest of the body. Damage to any part of the spinal cord or nerves may bring permanent changes in respiratory, bowel, lower urinary tract, and sexual functions. The quality of life of an individual may be affected and affects emotionally, mentally, and socially.
What Is Spinal Cord Injury?
The spinal cord has a protective layer of tissue called meninges and spinal bones. These help protect the spinal cord. Spinal cord injury (SCI) usually occurs due to a traumatic blow to the vertebrae (spinal bone). Injured bones then affect the spinal cord and its nerves. Around 11000 individuals are diagnosed with spinal cord injury annually in the United States. As only 1% of affected people recover completely from neurological issues, the goal is to give maximum care to attain a good quality of life.
SCI can damage the nerves associated with bladder function. The level and severity of the injury determine how the bladder gets affected. Despite good care, individuals with SCI show complications like pressure ulcers and urinary tract complications. Urologic complications may account for 10 to 15% of deaths among such populations. It is challenging for individuals affected with SCI to manage urologic complications. If managed well, their quality of life would be great.
SCI may affect the following functions:
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Bladder and intestinal function.
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Breathing.
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Heart rate.
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Metabolism.
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Muscle movement.
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Reflexes and sensations.
SCI may be caused due to
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Falls.
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Motor vehicle accidents.
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Injuries during sports.
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Accidents during diving.
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Injuries caused during violence.
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Infections that cause abscess formation on the spinal cord.
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Birth injuries that cause SCI.
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Injuries caused during sports.
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Wounds caused due to gunshots.
Conditions like rheumatoid arthritis, infections, cancer, and osteoporosis may weaken the spine responsible for protecting the spinal cord. Spinal stenosis may also cause injury to the spinal cord. This may be due to the aging process.
Symptoms of SCI include
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Weakness in arms and legs may be observed.
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Reduced sensation in legs and arms.
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Loss of control over the bowel and bladder is seen.
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Severe pain or pressure in the neck or back can be observed.
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Lumps may be observed along the spine.
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Breathing difficulty may be observed.
An injury at the upper level of the spinal cord may cause spastic bladder or reflex bladder. In this condition, the reflex is triggered when the bladder is full. This reflex causes the contraction of bladder muscles to release urine. Individuals affected by such problems won't know when this situation occurs. These individuals also face problems with relaxing bladder muscles. Hence, they are not able to empty the urine.
An injury at the lower level of the spinal cord may cause a flaccid bladder. In this type of condition, there is an absence of contraction of the bladder muscles. This affects the release of urine from the bladder. This causes the bladder to be too full, leading to bladder damage and other problems.
What Are the Urological Aspects of Spinal Cord Injury?
Urological aspects of spinal cord injury include urinary incontinence, urinary tract infection, upper urinary tract distress, urinary calculi, autonomic dysreflexia, and bladder cancer. SCI may obstruct communication between the nerves in the spinal cord and the brain. When the nerves in the spinal cord that control the function of the bladder and bowel get affected causes an interruption in communication with the brain, causing urinary incontinence. This condition is also known as neurogenic bladder or neurogenic bowel.
Neurogenic Bladder:
In SCI, swelling can be observed in the spinal cord. This swelling stops the blood flow and oxygenation to the spinal cord tissue. Axons and neural cells get damaged. Bleeding occurs and spreads to other areas of the spinal cord. These changes bring about a condition known as spinal shock. This leads to inhibition of all the reflexes and functions below the level of spinal cord injury.
Urinary Tract Infection:
Urinary tract infection (UTI) is the most commonly occurring condition in SCI. The risk of UTI gets increased due to incomplete emptying of the bladder, reduced bladder wall compliance, and insertion of a catheter. Urine remained due to incomplete emptying, acting as a medium for bacterial growth. Low bladder wall compliance causes upper UTI, affecting the entire urinary tract. Due to the long-term usage of catheters, an increase in the count of bacteria may be observed. Organisms involved in UTI are gram-negative bacilli and enterococci.
Deterioration of Renal Function:
Renal insufficiency is mainly observed among patients with SCI. Factors causing renal insufficiency are recurring UTI and renal calculi.
Urinary Calculi:
Immobility causes urinary stasis. This leads to the formation of crystals in the urine. These crystals grow to form urinary calculi. These stones generally are infected among patients affected with SCI. These urinary calculi attract bacteria and also obstruct the urinary tract.
Autonomic Dysreflexia:
This condition is life-threatening due to irritating stimulus caused due to SCI. Tachycardia and increased blood pressure may be seen. Stimulus includes distension of the bladder and bowel and sexual activity. Symptoms of this condition include a pounding headache, sweating, chest tightness, and difficulty breathing.
Bladder Cancer:
Bladder cancer is 16 to 28 times higher among individuals affected with SCI when compared to other individuals. Squamous cell carcinoma is more common among individuals affected with SCI. Besides smoking as a risk factor, another prevalent risk factor for bladder cancer is prolonged use of indwelling catheters among those affected with SCI.
Individuals with SCI show a greater suicidal rate when compared to the general population. These individuals with neurogenic bladder face depression. Women are more affected by depression than men. The quality of life gets diminished because of depression among these individuals.
Conclusion
Spinal cord injury causes many urological problems. These urological aspects must be dealt with carefully for a good quality of life. Hence, knowing about spinal cord injury and its urological aspects becomes important.
